Connect Care Manual - Goals of Care Designations

Connect Care Goals of Care Designation Definitions

Connect Care Goals of Care Designation (GCD) orders are matched to definitions adopted in the province of Alberta.

R = Medical Care and Interventions, Including Resuscitation

Goals of Care directed at cure or control of a patient’s condition. The patient would desire ICU care if it was required, and would benefit from ICU if their medical condition warranted it.

R1 = Medical Care including ICU admission if required, with intubation and chest compressions

Patient is expected to benefit from, and is accepting of, any appropriate investigations and interventions that the health system can offer, including physiological support in an ICU setting if required. All appropriate supportive therapies are offered, including intubation. Chest compressions and intubation are performed during a resuscitative effort when clinically indicated.

R1 Guide

Goals of care are directed at cure or control of a patient’s condition. Treatment of illness may include transfer to an acute or tertiary care facility with admission to the ICU if indicated. Intubation or chest compression may be provided.

General guidelines – this designation is for patients who would benefit from, and are accepting of, any appropriate investigations and interventions that the health system can offer, including physiological support in an ICU setting if required. All appropriate supportive therapies are offered, including intubation. Chest compressions and intubation are performed during a resuscitative effort when clinically indicated.
Resuscitation – is undertaken for cardio respiratory arrest or acute deterioration.
Life Support Interventions – are usually undertaken
Life Sustaining Measures – are used when appropriate within overall goals of care.
Major surgery – is considered when appropriate. The possibility of intra- operative complications including death and the requirement for physiological support post operatively should be addressed with the patient in advance of the proposed surgery, and general decision- making guidance agreed upon.
Transfer from current location of care – is considered if an alternative location is required for diagnosis and treatment.

R2 = Medical Care including ICU admission if required, with intubation but without chest compressions

R2 Guide

Goals of care are directed at cure or control of a patient’s condition. Treatment of illness may include transfer to an acute or tertiary care facility with admission to the ICU if required. Intubation can be considered when indicated but chest compressions are not performed.

General guidelines – this designation is for patients who would benefit from, and are accepting of, any appropriate investigations and interventions that the health system can offer, including physiological support in an ICU setting if required, but excluding chest compressions.
Resuscitation - is undertaken for acute deterioration, but chest compressions should not be performed.
Life Support Interventions – may be offered, without chest compressions.
Life Sustaining Measures – are used when appropriate within overall goals of care.
Major surgery – is considered when appropriate. The possibility of intra-operative complications including death and the requirement for physiological support post operatively should be addressed with patient in advance of the proposed surgery, and general decision-making guidance agreed upon.
Transfer from current location of care – is considered if an alternative location is required for diagnosis and treatment.

R3 = Medical Care including ICU admission if required, without intubation or chest compressions

R3 Guide

Goals of care are directed at cure or control of a patient’s condition. Treatment of illness may include transfer to an acute or tertiary care facility with admission to the ICU if required, but chest compressions or intubation should not be performed.

General guidelines – this designation is for patients who would benefit from, and are accepting of, any appropriate investigations and interventions that the health system can offer, including physiological support in an ICU setting if required, but excluding intubation and chest compressions.
Resuscitation -is to be undertaken for acute deterioration but chest compressions or intubation should not be performed.
Life Support Interventions - may be offered without intubation or chest compressions.
Life Sustaining Measures – are used when appropriate within overall goals of care.
Major surgery – is considered when appropriate. The possibility of intra-operative complications including death and the requirement for physiological support post operatively should be addressed with patient in advance of the proposed surgery, and general decision-making guidance agreed upon.
Transfer from current location of care – is considered if an alternative location is required for diagnosis and treatment.

M = Medical Care and Interventions, Excluding Resuscitation

Goals of care directed at cure or control of a patient’s condition. These patients either choose to not receive care in an ICU or would not benefit from ICU care.

M1 = Medical care with transfer to Acute care when required and without the option for life-saving ICU care

Directed at cure or control in any location of care, without accessing a tertiary level ICU. Treatment of illness may include transfer to an acute or tertiary care facility. All active medical and surgical interventions aimed at cure and control of conditions are considered, within the bounds of what is clinically indicated, and excluding the option of admission to a tertiary level ICU for life-saving interventions. If a person deteriorates further and is no longer amenable to cure or control interventions, the goals of care designation should be changed to focus on comfort primarily.

M1 Guide

The goals of care are aimed at cure or control in any location of care, without accessing a tertiary level ICU. Treatment of illness may include transfer to an acute or tertiary care facility without admission to a tertiary level ICU.

General guidelines – all active medical and surgical interventions aimed at cure and control of conditions are considered, within the bounds of what is clinically indicated, and excluding the option of admission to a tertiary level ICU for life-saving interventions. If a person deteriorates further and is no longer amenable to cure or control interventions, the goals of care designation should be changed to focus on comfort primarily.
Resuscitation – is not undertaken for cardio respiratory arrest.
Life Support Interventions – should not be initiated, or should be discontinued after discussion with patient or alternate decision- maker.
Life Sustaining Measures – are used when appropriate within overall Goals of Care.
Major surgery – is considered when appropriate. Resuscitation during surgery or in the recovery room can be considered, including short term physiological and mechanical support in an ICU, in order to return the patient to prior level of function. The possibility of intra-operative death (option: life-threatening intra-operative deterioration) should be discussed with patient in advance of the proposed surgery, and general decision- making guidance agreed upon.
Transfer to another location of care – is considered if that location provides more appropriate circumstances for necessary diagnosis and treatment.

M2 = Medical care without transfer to Acute care and without the option for life-saving ICU care

Directed at cure or control, almost always within the patient’s current care environment, without transfer to acute or tertiary care. All interventions that can be offered in the current non-hospital location of care are considered. If a person deteriorates further and is no longer amenable to cure or control interventions in that location, the goals of care designation should be changed to focus on comfort primarily.

M2 Guide

The goals of care are aimed at cure or control, almost always within the patient’s current care environment. Treatment of illness may be undertaken in the current location without transfer to acute or tertiary care should that condition deteriorate.

General guidelines – all interventions that can be offered in the current location of care are considered. If a person deteriorates further and is no longer amenable to cure or control interventions in that location, the goals of care designation should be changed to focus on comfort primarily.
Resuscitation – is not undertaken for cardio respiratory arrest or acute deterioration.
Life Support Interventions – should not be initiated or should be discontinued after discussion with patient.
Life Sustaining Measures – are used when appropriate within overall goals of care.
Major surgery – is not usually undertaken, but can be contemplated for procedures aimed at symptom relief. Resuscitation during surgery or in the recovery room can be considered, including short term physiological and mechanical support in an ICU, in order to return the patient to prior level of function. The possibility of intra-operative death (option: life- threatening intra-operative deterioration) should be discussed with the patient/family in advance of the proposed surgery, and general decision-making guidance agreed upon.
Transfer to another location of care – is not usually undertaken, but can be contemplated if symptom management or diagnostic efforts aimed at understanding symptoms can best be undertaken at that other location.

C = Medical Care and Interventions, Focused on Comfort

Goals of care directed at symptom control rather than at cure or control of a patient’s underlying condition that is expected to result in death. All interventions are for symptom relief.

C1 = Symptom Comfort Care

Directed at maximal symptom control and maintenance of function, rather than cure or control of the underlying condition. A diagnosis exists which is expected to cause eventual death. New illnesses are not generally treated unless control of symptoms is the goal. Treatment of intercurrent illness can be contemplated only after careful discussion with the Patient about specific short term goals. Transfer to another location of care is not usually undertaken, but can be contemplated if symptom management or diagnostic efforts aimed at understanding symptoms can best be undertaken at that other location.

C1 Guide

Goals of care are for maximal symptom control and maintenance of function, without cure or control of the underlying condition. A diagnosis exists which is expected to cause eventual death.

General guidelines – A diagnosis exists which is expected to cause eventual death. New illnesses are not generally treated unless control of symptoms is the goal.
Resuscitation – is not to be undertaken in the event of cardio respiratory arrest/failure. Chest compressions or intubation should not be performed.
Life Support Interventions - should not be initiated, or should be discontinued after discussion.
Life Sustaining Measures – can be used for goal directed symptom management.
Major Surgery – is not usually undertaken, but can be contemplated for procedures aimed at symptom relief. Resuscitation during surgery or in the recovery room can be considered, including short term physiological and mechanical support in an ICU, in order to return the patient to prior level of function. The possibility of intra-operative death (option: life- threatening intra-operative deterioration) should be discussed with the patient/family in advance of the proposed surgery, and general decision-making guidance agreed upon.
Transfer- should be contemplated if symptom management or diagnostic efforts aimed at understanding symptoms can best be undertaken at another location. Transfer to an ICU is warranted if ICU is deemed to be the best location for palliation, especially in the Pediatric environment.

C2 = Imminently Dying

Goals of care are aimed at preparation for imminent death (usually within hours or days), with maximal efforts directed at symptom control. Expert terminal care can be provided in any location. Transfer to another site is usually not undertaken due to risk of death during transport.

C2 Guide

Goals of care are aimed at preparation for imminent death (usually within hours or days), with maximal efforts directed at symptom control.

General guidelines – expert terminal care can be provided in any location.
Resuscitation – is not to be undertaken in the event of cardio respiratory arrest/failure. Chest compressions or intubation should not be performed.
Life Support Interventions – should not be initiated, or should be discontinued after discussion.
Life Sustaining Measures – should be discontinued unless required for goal directed symptom management.
Major Surgery – is not appropriate.
Transfer - to another site is usually not undertaken due to risk of death during transport.